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>> Good evening.

I'm so glad you're watching us here tonight on PBS Fort Wayne the name of our show is LIFE Ahead.

I'm the host is Sandy Thomson.

>> The real stars are my two guests that you're going to meet in just a moment.

Our main topic tonight is going to be aging in place and we have an attorney here this evening, the one that you're very familiar with that can help with any legal questions in that arena of aging in place .

And we have an expert in home health care that can answer any of our calls for that and calls that's what we want from you.

By the way, this is really your show.

I'll ask him some questions but I'd love for you to call in with anything you'd like to know.

(969) 27 twenty and if you will talk to us live on the air that's the best that way if they have questions back to you.

You're still right there on the phone.

But if you're not comfortable doing that, that's OK. Our phone operator will take your question and type it up and send it out here to us on the teleprompter rules.

We don't have any except that we don't have any commercials we go straight through for this half hour again aging in place and don't forget to give us a call.

>> Heidi Adair is our attorney that's with us here this evening.

Heidi, welcome.

Hi.

Thank you.

What a pretty color.

>> I just thank you.

Now I noticed your sweater there.

That looks great.

Thanks, Heidi.

You've met many times with us here.

>> We were talking before the show how many times she's been here and we figured about four times a year for about 20 years I think so you're way back OK, and you'll be here for 20 more I'm sure.

>> Yeah.

Yeah.

Kevin NIMBies Kevin , welcome to LIFE Ahead here and PBS and Kevin is an expert on home health care.

>> So I'm anticipating some phone calls about that.

>> People always seem to have questions and that's a business that I think probably changed a lot in the last 10, 15 years.

>> Yeah, it has it has the population changes have forced a lot of changes on the industry.

>> We were talking about some of those changes before the show, Heidi.

>> And and you were talking about baby boomers and how the need for elder elder law attorneys, the need for home health care, those kind of things has really increased.

>> Can you speak to that?

Yeah.

So I saw this slide.

I didn't make it up but it's it has had a huge impact on me.

People been turning sixty five at a rate like this and in twenty twenty three the graph went like this and it continues to go up like this for another fifteen years really.

So the baby boomers that we've all been talking about is who are going to be aging.

Yeah it's here like they are aging and what we've kind of been talking about and kind of preparing for for 10 or 15 years is kinda busy now.

>> Yes.

Is very busy.

Well what does health have to do with that idea or Kevin , both of you start with you, Kevin , because there's been so much more medical research technology people are living longer than they used to so those baby boomers you thought were going to be gone in five or ten years probably won't be.

Kevin , does this impact a home?

>> Yeah, there's a lot of like you said earlier changes that and that's certainly one of them.

We're seeing people live longer and people who are aging want to live healthy, productive, meaningful lives on into their 80s and 90s and even into their hundreds.

And so health care is changing and yeah.

>> So is it is it true and I think we have spoken some about this before, Heidi, that in general and you meet with people all the time that are beginning to do their estate planning or or prepare their documents and whatever would you say it's true that they want to stay home?

>> Yeah.

More than to go to to retirement homes or whatever.

I mean everybody kind of has their own spin on it.

But what you know, the generation of for us a lot of them didn't make it to you know, they just got sick and died.

And so what I'm talking to people about is you got to have a plan because you're likely going to live a long time and the way that you live today is probably not going to work for you as you age and you want to be in charge of your aging you want your aging to look the way you want it to look.

You don't want to do so.

You want to design and with all these people aging at the same time and limited resources, you're just going to be better off if you have planned ahead and know what you want.

>> Yeah, well we've talked about that with a number of different careers or businesses.

You know, builders have said think now if you're going to be building something new or while you're still healthy enough if you need to downsize and move somewhere else, think about those things whether it is like how wide the doors are in case you need wheelchairs, are there ramps availale or easily put in and things like that that-mao live at home?

>> Right.

Right a bit longer.

>> Do these things get impacted by home health care workers?

Yeah.

Kevin , I mean do you require certain things appliance if you're going to send somebody out to take care of them?

>> Yeah, well just to kind of tack on to what you were saying in terms of planning planning is so important and a lot of times we end up talking to families who are already in crisis mode.

Something has happened so fall has happened or a hospital visit or a diagnosis or something like that has happened and now the family is scrambling to try to figure out OK, what how does mom or dad want to live out their days and what can be done?

How do we kind of honor their wishes in that?

Yeah.

And so one of the messages I would love to share is just communicating as a family beforehand before that crisis so that everyone kind of knows this is what we want.

This is how we want.

And so the decision can be with in our case it's a client but it can be with that aging adult.

>> What are the things that we've talked about before here on like the head in terms of preparing for that is to try to make sure that again like and said that you communicate and sometimes people aren't always comfortable doing that or they know.

>> Do you think it's because it means you have to face mortality if you're starting to tell your kids, OK, here's what I want.

>> Yeah, maybe and and I think to they you know the older generation today did not see aging modeled.

They they're they're the first people navigating this so they kind of just are looking at what they watched their parents do.

>> Yeah.

Which isn't going to work very well now because you're going to live longer than your parent lived and so they haven't had somebody to kind of model it for them and in past generations I think too I don't know if it's a big deal now but in past generations more people were home.

>> I mean there were fewer both people.

>> Yeah.

Like the son or daughter, whatever they and their spouse working.

>> So they're usually family family members that could stay at home and take care of grandpa and grandma whatever.

>> And now everybody seems to be so busy and everybody's working.

So yeah, there's not always somebody in the family available.

>> Kevin , you said oftentimes it's an emergency when people call you up and say hey, I need something, you know right.

>> Help.

Yeah.

Is it like an accident or is it like post surgery?

>> What's the usual case?

Yeah, a lot of falls sometimes it's a fall that kind creates that crisis where the family then needs to get some more help in the home.

It could be a diagnosis.

So if you're diagnosed with cancer and you know you're looking a treatment that might also you know, the healing process also takes a lot out of you for sure.

And so you might need a little bit more help at home than you needed before.

And I think one of the keys to this generation and probably a lot of generations is they want independence.

They want that independence and home care is one of those things that some people are a little resistant to.

It's like oh this is going to take my independence away but really I see it as a different side of it where it really brings that independence so the aging adult can live their life , how they want to live their life and if they need a little bit of help with dressing or if they need a little bit of help with running a vacuum or doing some laundry, then they've got that help but they also can do what they want to do so.

>> Now how does it work?

How do you decide what level of care somebody needs?

You know, I mean from what I have heard, you know, you can hire somebody to come in a couple of hours a day to make sure you're mad that you're taking your medicine correctly and like Kevin mentioned, maybe to do some household tasks to back room or do the dishes or whatever or maybe take you to the grocery or drug store doctor's appointments, things like that or you can go all the way up to 24 hours a day if you need that.

>> You get a little costly though wouldn't it?

Yeah yeah but but maybe that's a preference for some people rather than being in a Yeah.

A center of some sort yeah.

How long does it take when someone calls you before you can get them situated.

>> Yeah well it varies but today was a great example we had two calls this afternoon we went out and met with the client and did an assessment so that's typically what would happen is somebody would do an assessment or you go to their home, we go to a client house.

>> Yeah.

See what you know what they need and then develop a care plan based on that.

Yeah.

And one we started at five o'clock tonight and the other we're starting at seven in the morning so it was pretty quick turnaround.

Wow.

Doesn't always happen that way but sometimes that's we scramble and we make it happen for him.

>> So what kind of training do the home health care workers get and well I'll make this double question here Heidi mentioned you know with the baby boomer increase and whenever obviously that's impacting your business so you have a lot more requests for home health care than you would have ten years ago or five years ago.

Can you keep enough staffing?

Are there enough people available and how do you train them?

>> Yeah.

Yeah, well staffing is a big challenge.

Yeah.

And but we work really hard to to find the best caregivers in Fort Wayne and the training that we do is is all in-house.

So there's really it's a nonmedical situation so all of our training is on personal care and how to you know, do the things that someone would need to do to help someone if maybe there's an incontinence issue or maybe they need a little help to be safe in the shower, you know those kinds of things.

But we do the training in-house and we get them ready and and then we support them as they're doing it.

>> Don't do they have to have any sort of licensing or training prior to starting to work on the staff?

>> No, we look sorry do we look for a lot of heart?

I mean we look for people that are caregivers by nature they've probably done some caregiving in their past whether it's their family or a friend or or a grandmother and if they've got that caregiver heart then we'll teach them the the skills that they need to be able to handle those situations like that.

And so that's great because it really is that I mean I mean if I had, you know, a family member that needed home health care, I'd want somebody that really cared about them and and that I trusted and there's you know, some people just need home care health care there are there's also health care.

>> So I mean I don't know can you help with medicines you now we can do medication reminders but there's kind of a line that we can't do some of the we can't do the medical things OK but there are companies that do that.

Yeah.

Sometimes you need to employ both types of of OK that's a good point.

>> Yeah.

I mean there may be a need to have a nurse stop in every day if you need an insulin shot or certain medications you know they know how to make sure you get those or to give you the the shots or whatever but obviously they would be medically trained.

Exactly yeah.

And licensed yeah.

OK all right that's good.

>> OK let's go back and talk about legalities ok. All right.

>> Does anyone need any kind of legal documents to start requesting or hiring home health care if you are well enough to hire them yourself you can but this is where it's important that you if you couldn't if you weren't well enough to navigate all of that you want to have a power of attorney, a financial power of attorney, health care power attorney.

>> Is this something that the health care representative would take care of then or both of them they the health care representative kind of would manage making sure the health care was being done but the financial power of attorney would have to write the checks for it and pay for it.

So you need both both of them working on it.

OK, you should pay for it so we can do look at options maybe Medicaid or private pay.

How does at work yeah.

>> Yeah in our case there's several options for paying for services that we offer.

One would just be the private funds that the family would have.

The next would be there's a class of insurance called long term care insurance policies and so right.

Yeah if some if someone has those then they'll often have coverage for home care services.

The VA is also a wonderful source of of services if you qualify for that and then the Medicaid waiver program would be the final of the four big buckets that funding comes from.

>> All right.

Medicaid waiver I understand there's a bit of a waiting period on that right now, right?

>> Yeah.

Yeah.

So this is quite quite an interesting time in the Medicaid waiver world.

>> She says with a smile as her workload has increased.

>> Yeah.

So in March of twenty three the state realized there was a one billion dollar budget shortfall in the Medicaid program.

>> So in just the state of Indiana, just the state of Indiana.

OK, so in April and as a response to that in order to use Medicaid waiver, the state has to give you a slot.

So in April 4th with on April 4th with no warning they said no more slots until July like-au enrolled or you just have to be issued kind of a they have to give me a slot and then I can apply for Medicaid so I can apply for Medicaid until I have a slot.

>> OK, so the state said we're not going to give out like your placement of eligibility.

They kind of so in in our area aging and in-home services comes and assesses you and says yep you're sick enough we're going to have the state give you a slot and then you can apply for Medicaid.

>> So local aging and in-home services here in Fort Wayne .

>> So that might be a place you might call to explore more give more information, find out more and ask them if they can do the assessment and that's a good thing.

>> Do you require anything like that, Kevin for Home Health Services the waiver program?

Yeah.

So we would need for this client to have been approved for the waiver.

>> OK, they've got to make it through this waitlist which can be pretty long these days because of the changes that have been going on with the program.

But once they get through that waitlist and they're released from that, they'll be authorized to either receive home care services or any of the other services that they might be eligible for Medicare help at all Heidi.

>> You know, they can help maybe for brief periods can take care of her.

>> Do any sort of rehab coverage unfortunately no.

>> I mean they really do stick to the medical side of it so they may be able to help cover some of the medical needs that you might have at home but not necessarily a whole nonmedical home care.

>> The home care.

Yeah.

Yeah.

So if you're in a rehab situation you might get some physical therapy or occupational therapy covered by Medicare but not the meal preparation and cleaning that writing.

>> Right.

And sometimes those are needed more than anything, right?

Yeah.

You know and tell me if I'm wrong Kevin but you've mentioned falls twice and is my understanding that throw rugs around the house or one of the main reasons for falling?

tripping hazard and clutter in the house can be another one that can cause falls tight spaces without handrails is probably the third thing that we look for .

So in bathrooms getting those handrails put in place are really helpful and that's not really that hard.

>> I know we did that for my brother installed that was for my mother after she had had some significant surgery and you know it was not that big of a deal.

>> I say that I didn't do a I think she just went to like I don't know Home Depot or Lowes or someplace like that and you can buy the metal railings to put in the bathroom, you know, in the shower or bathtub area extremely important.

Yeah.

Crispell in the bathtub or in the shower.

>> Yeah, it could break your hip.

Yes, yeah yeah yeah.

And of course in Indiana we have half the year we're worried about ice and snow and things like that.

>> Yeah.

>> As far as care that they're giving people at home Kevin you know there may be a daily tasks like we talked about and do you give them training on things like moving somebody from the bed into the wheelchair or things like that?

>> Yeah, some mobility support is probably another area or category that we specialize in and absolutely we do a lot of training.

So ability care.

Yeah.

Mobility support OK and so yeah we don't want our caregivers to get hurt while they're Yeah.

Helping somebody stand up or rotate or making sure they're not falling and so we teach them how to do that safely.

>> OK yeah.

All right that makes sense Heidi with clients that are coming to you we talked about legal documents it does estate planning and get involved in any way with this or what should I mean part of it but I mean my main message that I wanted to share tonight was that with these changes in the Medicaid waiver program you may be on a waiting list for four months.

So if if that's months that was plural.

Yes.

If that's if you don't have funds to pay for home services on your own and you want to use the Medicaid program, you have got to start early now and you probably need the help of an attorney to help you do it and that's the main thing that I just kind of wanted to get out right now is that such a change?

>> Right.

So to use your terminology then if you want to try to get Medicaid assistance with home services, get your slot in my all right.

>> And again you could call aging and in-home services to to find out a little bit more of what the requirements might be.

>> Kevin , what advice would you give to people that maybe don't need anything now but you never know?

>> Yeah.

So what would you tell people in terms of preparation, if you will?

Right.

I think the biggest thing that I would recommend for people to do is just to communicate with their family, with their friends, with lawyers, you know, other people that are in their circle and what I mean by communicate is, you know, everyone has hopes and dreams.

They have ideas of what that what aging looks like and there are some fears there.

But I think there's nothing to fear and there's a sense of life can be full at any age.

Life can be meaningful at any age and start talking about what that means to each individual person and what their desires are and communicate this with you know, with your family.

>> And you know, Kevin , as people start to age and we all know this it's OK to start hiring help.

>> Yeah.

Hire the kid in the neighborhood to mow your yard for you or to climb up on that ladder to clean the gutters or just you know some things like that or maybe you want to start to hire somebody to help with some of your home repair that you used to be able to do yourself so it's a good idea to hire help.

>> This is one way you physically favorite client stories.

OK, son and daughter mom is the mess they come in.

We got to do something OK, let's just get our bearings but let's stabilize the situation.

So she already was having her house cleaned and that person started coming in three days a week and helping with some meals.

The neighbor person was mowing the lawn and taking out the trash.

Yeah, someone was helping with laundry.

They come back mom is fine like allowed Mom to stay in her home for two extra years.

>> Amazing.

Yeah, amazing nutrition and cleaning is such a big deal that you think people can take care of on their own but that's harder than it seems when you're dealing with health issues.

>> Well, it maybe maybe they can't even drive anymore so I'm going to work well and the good thing good news is there are so many opportunities now and again to you know, through a company you can get some home help, home care help and there are so many grocery delivery drugstore deliveries so there's no reason for you to like not get some help.

>> Gloria called in by way and Gloria says How does one qualify for Medicaid?

>> So Medicaid is program that is it reviews what your income level is and what your asset level is.

And at first blush it looks like the asset levels have to be very low in order to qualify.

Yeah, but when you are in a married couples situation that by hiring an elder law attorney hoops they tell you to jump- through often you can get your spouse on Medicaid.

Oh yes.

So for a married couple for married couple what is a single person a single person with assets?

>> There's also avenues to try to protect some of those assets if you kind of plan ahead.

So if you're a person who has assets, it's worth a consultation with an elder law attorney just to see how right it all might work and sometimes I think from from what you tell us it with the help maybe of an attorney or a financial planner you can do asset protection right.

>> Or a way to arrange your finances so you might be eligible for Medicaid.

OK, we have thirty seconds real quick.

>> Yeah.

What would you tell our folks at home?

Yeah.

Yeah I would say I guess just don't stop dreaming and don't stop living life to the fullest and good and and you can get some help to help you to do that no matter what age you are.

>> I like that.

I like that and you know you can what I mention with that that one lady she was able to stay home several more years.

>> Right.

By just getting a little bit of help.

>> OK, thank you.

You've helped our viewers and I mean as well with some information here and education and that's our intent here at PBS and in a talk show like The Hand to help you get a lot of information to help you make choices for your LIFE Ahead.

And I'll be back next Wednesday night at seven thirty with a new topic and new guests.

Meanwhile, you all have a good night.

>> Stay safe and stay healthy